Search

Share:

The Internet site that you are about to view is an online educational resource intended
for medical professionals based in the United Kingdom. The site contains up-to-date
information on The Binding Site’s products, and may therefore contain information on
medical devices and other products or uses of those products that are not approved or
cleared in other countries or regions.
This site is not intended to promote off label use of any of The Binding Site’s
products. To obtain appropriate product information for your country of residence,
please contact your local distributor.

View source:

In current myeloma practice, patients are categorized at presentation using the ISS, based upon serum albumin and β2M measurements alone [428][429]. Kyrtsonis et al. [439] found that within each ISS stage, patients with an elevated involved/uninvolved sFLC ratio (>median) had reduced survival compared with those with less elevated values (<median). Furthermore, by combination of the ISS with sFLC ratios it was possible to divide the patient population into three groups with clearly divergent disease-specific survival (Table 20.2 and Figure 20.3).

Snozek et al. [365] used extreme κ/λ sFLC ratios (<0.03 or >32) as an additional risk factor to those of the ISS (serum β2M >3.5 g/L, serum albumin <35 g/L) to separate patients (n=790) into four groups with 0, 1, 2, or 3 risk factors. These groups had median overall survival of 51, 39, 30 and 22 months, respectively (p<0.001). Because these data provided additional outcome information, it was suggested that sFLC ratios should be incorporated into the ISS to provide a new risk stratification model. In a study including 122 Chinese MM patients, Xu et al. [444] used similar κ/λ sFLC ratio boundaries (<0.04 or >25) to add a third risk factor to the ISS. This produced four patient groups with clearly separate survival curves (Figure 20.4) and the authors again concluded that the prognostic potential of the ISS could be improved by incorporating sFLC ratios.

Further evidence of the independence of sFLC ratios as a risk factor was provided by Esteves and colleagues [445], who used abnormal κ/λ ratios (<0.03 or >32) to separate patients within the ISS stage II (but not stage I or III) into groups with different overall survival. Whereas a study by Meddour et al. [1053] used the same cut-offs to further stratify ISS stage III patients for overall survival.